Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents following high-energy pelvic trauma (e.g., MVC, fall from height). Chief complaints include inability to void, gross hematuria, and suprapubic pain. History is significant for pelvic fracture. Absence of spontaneous micturition noted since the time of injury.
Clinical Examination Findings
Physical examination reveals blood at the external urethral meatus. Abdominal exam shows a palpable, tender, distended bladder. Rectal exam performed to assess prostate position; high-riding or non-palpable prostate noted, suggestive of urethral disruption. Pelvic stability assessment indicates potential fracture.
Treatment Protocol
Immediate stabilization of pelvic fracture. Retrograde urethrography (RGU) is mandatory prior to any catheterization attempt. If urethral disruption is confirmed, avoid blind catheterization. Initial management involves suprapubic cystostomy for urinary diversion. Delayed primary endoscopic realignment or delayed urethroplasty to be planned based on injury severity.